Healthcare Provider Details

I. General information

NPI: 1578037024
Provider Name (Legal Business Name): NATALIE DANIELLE BULLOCK LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/17/2019
Last Update Date: 03/20/2025
Certification Date: 03/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4787 HIGHWAY 151
DOWNSVILLE LA
71234-5145
US

IV. Provider business mailing address

PO BOX 792
BASTROP LA
71221-0792
US

V. Phone/Fax

Practice location:
  • Phone: 985-805-6068
  • Fax: 504-930-4019
Mailing address:
  • Phone: 318-283-8887
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number7751
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number7751
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: